Provider Demographics
NPI:1275817447
Name:WEINER, JAN MERYL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:MERYL
Last Name:WEINER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 E 27TH ST
Mailing Address - Street 2:APT 9P
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9017
Mailing Address - Country:US
Mailing Address - Phone:908-294-3391
Mailing Address - Fax:
Practice Address - Street 1:137 E 36TH ST
Practice Address - Street 2:SUITE #4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3528
Practice Address - Country:US
Practice Address - Phone:212-686-6886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019054-1103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical